Training Primary Care Teams in HIV Pre-Exposure Prophylaxis: A Longitudinal Survey Study

Background: Despite the Center for Disease Control (CDC) recommendation to prescribe HIV pre-exposure prophylaxis (PrEP) to high-risk patients, few primary care providers (PCPs) are doing so. At the beginning of our study period, a needs assessment survey revealed only two PCPs providing PrEP in New Mexico (NM). To date, little data has been published on methods to educate PCPs on PrEP.  Our study aimed to assess the baseline knowledge and attitudes of PCPs in NM around PrEP, and assess the effectiveness of an educational intervention in improving these fields.

Methods: An educational intervention was developed for all members of the primary care team, aimed at teaching the safe administration of PrEP.  This included two interactive, case-based, hour-long sessions. We gathered demographic information on the providers and their patient populations. Voluntary de-identified pre- and post-intervention survey data on the awareness and comfort level of prescribing PrEP were collected. Knowledge on safely prescribing PrEP was assessed using a pre- and post-intervention test.

Results: Complete data were collected from 63 subjects (65% prescribers, 99% in primary care). As all survey questions assessed awareness and comfort, we used a construct composed of 6 of the 7 survey questions. The mean score of the post-survey results was significantly higher than that of the pre-survey (t=-18.14, df=58, p=<.0001; paired t-test; Figure 1). To assess knowledge of safely prescribing PrEP, we used a construct composed of the 7 pre- and post-test questions. The median score of the post-tests was significantly higher than that of the pre-tests (statistic =618, p=<.0001; Wilcoxon Signed Rank test; Figure 2)

Conclusion: We discovered a lack of awareness of PrEP among PCPs in a metropolitan area in NM.  However, providers previously uncomfortable with prescribing PrEP became willing to do so after our educational intervention.  The effectiveness of the training was also reflected in the significant improvement of test scores. We demonstrated an effective educational intervention in clinical settings and increased the number of PrEP-trained prescribers in NM to over 40, thus improving access to PrEP for high-risk patients.